Medicare is comprehensive, but it has real limits. Many people discover the gaps only after they’ve enrolled — when a dentist bill arrives or a hearing aid estimate lands on the desk. Knowing what Medicare won’t cover before you need it lets you plan, budget, and find alternatives before costs catch you off guard.
The biggest gaps in Medicare coverage
Dental care
Original Medicare (Parts A and B) does not cover routine dental care: exams, cleanings, fillings, extractions, dentures, or most oral surgery. The only dental care Medicare covers is treatment that is directly tied to a covered medical procedure — for example, jaw reconstruction after an accident covered under Part A.
This is one of the most significant and surprising gaps. About half of Medicare beneficiaries have no dental coverage, and dental costs in retirement can be substantial. Options to fill the gap include dental insurance (often available as a rider on Medicare Advantage plans), dental discount plans, community health centers, and dental schools that offer reduced-cost care.
Vision care
Medicare does not cover routine eye exams for glasses or contact lenses, and it does not cover eyeglasses or contacts themselves. It does cover medically necessary eye care — treatment for conditions like glaucoma, macular degeneration, cataracts (surgery is covered), and diabetic retinopathy.
For routine vision care, Medicare Advantage plans often include a vision benefit. Stand-alone vision insurance is also available at relatively low cost through AARP and other organizations.
Hearing aids
Hearing exams and hearing aids are not covered by Original Medicare. This is a major gap — hearing aids can cost $2,000–$6,000 per pair and are rarely covered by supplemental insurance either.
Some Medicare Advantage plans have added hearing benefits in recent years, though coverage varies widely by plan. Costco Hearing Aids and OTC hearing aids (now available without a prescription) offer lower-cost alternatives for mild-to-moderate hearing loss.
Long-term care
Medicare does not cover custodial care — the help with daily activities (bathing, dressing, eating, toileting) that makes up the core of long-term care. This is the biggest financial risk in retirement for many people.
Medicare will cover skilled nursing facility care after a qualifying hospital stay, but only for up to 100 days and only for skilled medical needs like rehabilitation or wound care. Once you no longer need skilled care, Medicare coverage stops — even if you still need help with daily activities.
Long-term care insurance, Medicaid (for those who qualify), and self-funding are the primary ways people cover this risk. See our article on How to Plan for Long-Term Care Costs.
Routine foot care
Medicare does not cover routine foot care: nail trimming, corn and callus removal, or general foot hygiene. It does cover foot care that is medically necessary due to diabetes or other conditions affecting the feet. If you have diabetes, your foot exams may be covered; routine care for people without such conditions is not.
Cosmetic surgery
Elective or cosmetic surgery is not covered. However, reconstructive surgery following an accident or disease, or to correct a congenital deformity, may be covered under Part A or Part B depending on the situation.
Acupuncture (mostly)
Medicare covers acupuncture only for chronic low back pain — up to 12 sessions in 90 days, and up to 8 additional sessions if the patient is improving. All other acupuncture is not covered.
Services outside the United States
Original Medicare generally does not cover health care received outside the United States (with narrow exceptions for certain Canadian and Mexican border situations). If you travel internationally, you need separate travel health insurance. Some Medigap plans (C, D, G, M, N) include emergency foreign travel coverage up to a lifetime limit.
Most prescription drugs (under Original Medicare)
Original Medicare Parts A and B do not cover most outpatient prescription drugs. Part D is a separate plan you must enroll in (or get through a Medicare Advantage plan) to have drug coverage. Without Part D, you pay full price for prescriptions.
🆓 Gaps in Medicare coverage? There are options.
Our partner Chapter Medicare offers free help from licensed advisors who can review your specific situation, explain your coverage options, and help you find a plan that fills the gaps that matter most to you.
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How to fill Medicare’s gaps
Medigap (Medicare Supplement Insurance)
Medigap plans help pay the cost-sharing gaps in Original Medicare — deductibles, copays, and coinsurance. They do not cover dental, vision, hearing, or long-term care. Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N); Plan G is the most popular for new enrollees in most states. See our article on Medigap explained.
Medicare Advantage (Part C)
Medicare Advantage plans often include extra benefits that Original Medicare doesn’t cover: dental, vision, hearing, fitness memberships, and sometimes over-the-counter allowances. Coverage varies significantly by plan and by county. Trade-offs include network restrictions and prior authorization requirements.
Stand-alone dental, vision, and hearing insurance
Separate plans are available for dental and vision coverage. Hearing aid discount programs (like the one through AARP/UnitedHealth) are available as well. These are worth comparing to Medicare Advantage plans with similar benefits built in.
Long-term care insurance
Long-term care insurance specifically covers custodial care that Medicare won’t touch. Premiums are highest when purchased late; most advisors recommend buying in your 50s or early 60s if at all. Hybrid life/long-term care policies and short-term care insurance are alternatives to consider.
Does Medigap cover everything Medicare misses?
No. Medigap fills Medicare’s cost-sharing gaps (deductibles, copays, coinsurance for covered services) but does not add new categories of coverage. Dental, vision, hearing, and long-term care are outside Medicare entirely — Medigap doesn’t touch them. You need separate coverage or out-of-pocket funds for those.
Bottom line
Dental, vision, hearing, and long-term care are the four biggest coverage gaps most retirees face. Budget for them, explore supplemental options before you need them, and don’t assume Medicare covers everything just because you’re paying premiums. Understanding the gaps is the first step to filling them.
🆓 Want help finding a Medicare plan that covers more?
Our partner Chapter Medicare can review your options across all available Medicare Advantage and supplemental plans in your area — at no cost to you.
📞 Call 615-639-1937 | 🔗 askchapter.org/money
ALWAYS FREE. No obligation.
Disclosure: We may receive a referral from Chapter if you choose to use their service. Chapter is a licensed health insurance agency and is not affiliated with or endorsed by Medicare or any government agency.
Further Reading
- Medigap / Medicare Supplement Insurance Explained
- Medicare Advantage vs. Original Medicare
- Medicare Costs and Premiums
- How to Plan for Long-Term Care Costs
- Long-Term Care Insurance
- How to Choose a Medicare Plan
- Medicare Won’t Pay for These Retirement Costs
This article is for general educational purposes only and does not constitute insurance or financial advice. Visit medicare.gov or contact 1-800-MEDICARE, or consult a licensed advisor for guidance specific to your situation.
